Greenslopes Obstetrics & Gynaecolog: Dr Ken Law - Fibroids

FIBROIDS Dr Ken Law

MBBS (Hons 1), FRANZCOG Obstetrician and Gynaecologist - Greenslopes Private Hospital Fertility Specialists - Care Fertility Senior Lecturer - The University of Queensland

Anatomy of the Female Pelvic Organs

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au

Anatomy of the Female Pelvic Floor

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au

Laparoscopy or Robotic Myomectomy +/- Open Myomectomy - Consent Form The following will be performed: A tube is put into the abdomen and instruments passed down the tube to examine the inside of the abdomen and pelvis using a camera and video monitor. Sometimes, bands of fibrous tissue grow around the bowel or other organs. The doctor will remove the fibroid from the uterus. There is a chance that this may be performed via a laparotomy (open surgery).

Risk of surgery include: • Following removal of the fibroid(s), there may be a weakness in the uterus (womb). This may lead to potential complications during future pregnancies and deliveries, including rupture of the scar, which could lead to serious complications such as bleeding, as well as serious complications for the baby (including asphysia and stillbirth).

• The laparoscopic procedure may be converted to an open procedure (via a larger incision into the abdomen).

• Serious injury may result from the laparoscopic morecellator, including injury to the bowel, internal organs, and blood vessels.

• There is a risk of bleeding, which may require a blood transfusion. In the event of life-threatening bleeding that is not able to be controlled, a hysterectomy may be required as a life-saving procedure.

• Infection can occur, requiring antibiotics and further treatment.

• Bleeding could occur and may require a return to the operating room. Bleeding is more if you have been taking blood thinning drugs such as Warfarin, Aspirin, Clopidogrel (Plavix or Iscover) or Dipyridamole (Persantin or Asasantin).

• Deep bleeding inside the abdomen. This may need fluid replacement, blood transfusion or further surgery. This may mean a longer than expected stay in hospital and longer recovery time.

• Damage to other organs, such as bladder or bowel, which may need further surgery. This may mean a longer than expected stay in hospital and longer recovery time.

• If there is injury to the bowel, a segment of the bowel may need to be removed, and the bowel may need to be diverted to a bag on your abdominal wall to collect the bowel contents (colostomy). This is usually temporary, and you may need a subsequent operation to reconnect the bowel several weeks later.

• If there is injury to the ureters (the tubes draining urine from the kidneys to the bladder). then a stent may need to be inserted into the injured ureter, which needs to be removed at a subsequent procedure several weeks later.

• If there is injury to the bladder, this will be repaired by suturing, and you will need to have a catheter to drain the bladder for up to one week.

• The above injuries may not be able to be recognised at the time of surgery, and you may require further surgery if problems arise in the post-operative period.

• Rarely the gas, which is passed into the abdomen, can cause heart and chest complications.

• Infections such as pus collection in the abdominal cavity. This may need surgical drainage and antibiotics.

• Adhesions (bands of scar tissue) may form and cause a bowel obstruction. This can be a short term or a longterm complication, and may need further surgery.

• In some people, healing of the wound may be abnormal and the wound can be thickened and red and the scar may be painful.

• A weakness in the wound with the development of a hernia (rupture). This may need further surgery.

• Increased risk in smokers of wound and chest infections, heart and lung complications and thrombosis.

• Very low possibility of a fistula (a connecting passage between on area and another) developing.

• There is a possibility that the symptom(s)/pain you have been experiencing and the reason for this operation, may not resolve or worse as a complication of the procedure.

• The cause of pain/other symptoms sometimes cannot be found, if you are having an exploratory operation.

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au

Laparoscopy or Robotic Myomectomy +/- Open Myomectomy - Consent Form

• • •

Whilst it is intended that your symptoms will improve after surgery, there may be no improvement, or the disease and associated symptoms may recur over time.

Fibroids may recur in the future.

Whilst surgery aims to remove all visible fibroids, there may be fibroids deeper within the uterus that are not visible during surgery, and these may not be able to be removed at the time of surgery.

Dibroids are generally benign, but very rarely some fibroids may be malignant, and myomectomy may adversely affect the prognosis and potentially increase the risk of the cancer spreading. If the final histology shows malignancy, then further treatment including surgery may be required.

OTHER SPECIFICS TO BE DOCUMENTED BY DOCTOR:

I acknowledge that the doctor has explained; ̹ my medical condition and the proposed procedure, including additional treatment if the doctor finds some thing unexpected. I understand the risks, including the risks that are specific to me. ̹ the anaesthetic required for this procedure. I understand the risks, including the risks that are specific to me. ̹ Other relevant procedure/treatment options and their associated risks. ̹ my prognosis and the risks of not having the procedure. ̹ the no guarantee has been made that the procedure will improve my condition even though it has been carried our with the due professional care. ̹ the procedure my include a blood transfusion. ̹ tissues and blood may be removed and could be used for diagnosis or management of my condition, stored and disposed of sensitively by the hospital. ̹ If immediate life-threatening events happen during the procedure, they will be treated based on my discussions with the doctor or my Acute Resuscitation Plan. ̹ I was able to ask questions and raise concerns with the doctor about my condition, the proposed procedure and its risks, and my treatment options. My questions and concerns have been discussed and answered to my satisfaction. ̹ I understand I have the right to change my mind at any time, including after I have singed this form but, preferably following a discussion with my doctor. ̹ I understand that image/s or video footage may be recorded as part of and during my procedure and that these image/s or video/s will assist the doctor to provide appropriate treatment.

On the basis of the above statements, I request to have the procedure: Name of Patient ................................................................................................................................................

Signature .............................................................................. Date ..................................................................

I have explained to the patients all the above points and I am of the opinion that the patient understood the information.

Name of Doctor .................................................................................................................................................

Signature .............................................................................. Date ...................................................................

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au

Laparoscopy - Consent Form The following will be performed: A tube is put into the abdomen and instruments passed down the tube to examine the inside of the abdomen and pelvis using a camera and video monitor. Sometimes, bands of fibrous tissue grow around the bowel or other organs. If so, the doctor may need to cut these. The doctor may also need to operate on the pelvic organs.

Risks for surgery include: • Infection can occur, requiring antibiotics and further treatment.

• Bleeding could occur and may require a return to the operating room. Bleeding is more common if you have been taking blood thinning drugs such as Warafin, Aspirin, Clopidorgrel (Plavix or Iscover) or Dipyridamole (Persantin or Asasantin).

• Deep bleeding inside the abdomen. This may need fluid replacement, blood transfusion or further surgery. This may mean a longer than expected stay in hospital and longer recovery time.

• Damage to other organs, such as bladder or bowel, which may need further surgery. This may require conversion to laparotomy (an open incision into your abdomen), and may mean a longer that expected stay in hospital and longer recovery time.

• Rarely the gas, which passed into the abdomen, can cause heart and chest complications.

• Infections such as pus collection in the abdominal cavity. This may need surgical drainage and antibiotics.

• Adhesions (bands of scar tissue) may form and cause a bowel obstruction. This can be short-term or long-term complication, and may need further surgery.

• In some people, healing of the wound may be abnormal and the wound can be thickened and red and the scar may be painful.

• A weakness in the wound with the development of a hernia (rupture). This may need further surgery.

• Increased risk in smokers of wound and chest infections, heart and lung complications and thrombosis.

• Very low possibility of fistula ( a connecting passage between one area to another) developing.

• There is a possibility that the symptom (s)/pain you have been experiencing and the reason for this operation, may not resolve or worsen as a complication of the procedure.

• The cause of pain/other symptoms will improve after surgery, there may be no improvement, or the disease and associated symptoms may recur over time.

OTHER SPECIFICS TO BE DOCUMENTED BY DOCTOR: I acknowledge that the doctor has explained; ̆ my medical condition and the proposed procedure, including additional treatment if the doctor find something unexpected. I understand the risks, including the risks that are specific to me. ̆ the anaestheric required for this procedure. I understand the risks, including the risks that are specific to me. ̆ Other relevant procedure/treatment options and their associated risks. ̆ my prognosis and the risks of not having the procedure. ̆ that no guarantee has been made that the procedure will improve my condition even though it has been carried out with due professional care. ̆ the procedure may include a blood transfusion. ̆ tissues and blood may be removed and could be used for diagnosis or management of my condition, stored and disposed of sensitively by the hospital. I was able to ask questions and raise concerns with the doctor about my condition, the proposed procedure and its risks, and my treatment options. My questions and concerns have been discussed and answered to my satisfaction. ̆ I understand I have the right to change my mind at any time, including after I have signed this form, but preferably following a discussion with my doctor.

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au

Laparoscopy - Consent Form ̆ I understand that Image(s) or video footage may be recorded as part of and during my procedure and that these image(s) or video(s) will assist the doctor to provide appropriate treatment. ̆ if immediate life-threatening events happen during the procedure, they will be treated based on my discussions with the doctor or my Acute Resuscitation Plan.

On the basis of the above statements, I request to have the procedure.

Name of Patient ................................................................................................................................................

Signature .............................................................................. Date ..................................................................

I have explained to the patients all the above points and I am of the opinion that the patient understood the information.

Name of Doctor .................................................................................................................................................

Signature .............................................................................. Date ...................................................................

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au

Hysteroscopy Dilation and Curettage +/- Hysteroscopic Removal of Fibroids, Polyps and/or Adhesions - Consent Form

The following will be performed: Under an anaesthetic, the cervix is carefully widened until there is enough room to pass a telescope into the womb. The womb is then filled with fluid, which gives a better view of the inside. A telescope is used to see if there is anything abnormal inside the womb. The fluid is then drained out. The lining of the womb is usually scraped to collect cells. The lining of the uterus and any other tissue that looks abnormal inside the uterus is then removed and may be sent to pathology for tests.

Risks of • Infection can occur, requiring antibiotics and further treatment.

• Bleeding could occur and may require a return to the operating room. Bleeding is more common if you have been taking blood thinning drugs such as Warfarin, Aspirin, Clopudigreal (Plavic or Iscover) or Dipyridamole (Persantin or Asasantin).

• Bleeding that can be so heave that a blood transfusion may be needed. It may also need further surgery.

• Damage may occur to the uterus with rupture or perforation. This may require a laparoscopy and/or laparotomy, and/or longer stay in hospital than expected. In the event of uterine perforation, there is a risk of damage to other organs, such as the bowel or bladder, which may require further corrective surgery.

• Rarely, the procedure may not be able to be completed, due to narrowing of the inside of the cervix. If the condition continues, further surgery will be necessary.

• Infection in the uterus. This can cause heavy bleeding or discharge, worsening cramps or high fevers. The infection may affect the tubes and cause problems with getting pregnant in the future. Antibiotics are used to treat the infection.

• Fluid overload may occur from absorption of the fluid used to visualise the cavity of the uterus, and this may lead to problems with the cardiovascular system.

• Low sodium levels may occur, which may lead to neurological problems such as seizures, or death.

• If the fibroid is large, it may not be possible to remove the fibroid completely, and a second procedure may be required to remove the remains of the fibroid.

• Fibroids/polyps/adhesions may recur in the future.

• Symptoms may persist despite removal of the fibroids(s) or polyp(s).

I acknowledge that the doctor has explained; ̹ my medical condition and the proposed procedure, including additional treatment if the doctor finds something unexpected. I understand the risks, including the risks that are specific to me. ̹ the anaestheric required for this procedure. I understand the risks, including the risks that are specific to me. ̹ other relevant procedure/treatment options and their associated risks/ ̹ my prognosis and the risks of not having the procedure. ̹ that no guarantee has been made that the procedure will improve my condition even though it has been carried out with due professional care. ̹ the procedure may include a blood transfusion. ̹ tissues and blood may be removed and could be used for diagnosis or management of my condition, stored and disposed of sensitively by the hospital. ̹ if immediate life-threatening events happen during the procedure, they will be treated based on my discussions with the doctor or my Acute Resuscitation Plan. ̹ I was able to ask questions and raise concerns with the doctor about my condition, the proposed procedure and its risks, and my treatment options. My questions and concerns have been discussed and answered to my satisfaction.

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au

Hysteroscopy Dilation and Curettage +/- Hysteroscopic Removal of Fibroids, Polyps and/or Adhesions - Consent Form

̹ I understand that I have the right to change my mind at any time, including after I have signed this form but, preferably following a discussion with my doctor. ̹ I understand that image/s or video footage may be recorded as part of and during my procedure and that these image/s or video/s will assist the doctor to provide appropriate treatment.

Name of Patient ................................................................................................................................................

Signature .............................................................................. Date ..................................................................

I have explained to the patients all the above points and I am of the opinion that the patient understood the information.

Name of Doctor .................................................................................................................................................

Signature .............................................................................. Date ...................................................................

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au

Laparoscopy Post-Operative Advice Before leaving hospital make sure you have: • Prescriptions if required • Our contact details to make follow-up appointments If you require a medical certificate: • Please call 07 3188 5000, and the medical certificate will be emailed to you What to expect when you go home: • Overall recovery should take one to two weeks - you should be mobile within 24 to 48 hours though • Pain/discomfort at the wound sites may persist for 7 to 10 days • Shoulder pain may persist for up to 48 hours - this is from residual gas under the diaphragm • Nausea may be present for the first 24 to 48 hours Help you bowels move as soon as possible post-op, and avoid constipation: • Ensure adequate hydration • Use a combination of aperients, such as Movicol, Lactulose, Coloxyl, Benefibre The key-hole surgery incisions: • Have been closed with absorbable sutures, and should completely dissolve by 4-6 weeks • Have been covered with skin glue, which will gradually was away after 2-3 weeks Be aware of signs of infection • Hot flushes / high temperatures / sweats • Progressively worsening pain • Red, weeping wounds In the first 24 hours: • Get adequate rest - no heavy lifting, housework etc.

• Gently ease back to normal activities • Do not drink alcohol • Do not operate machinery • Do not sign legal documents You should not drive until you can put you foot on the brakes without any pain. Generally, this may take 2-4 weeks.

In the next 2 weeks: • Avoid heavy lifting or straining • Avoid intercourse • Use pads not tampons • Avoid spa baths If at any point you have concerns, please contact me immediately.

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au

Informed Financial Consent Consultation & Outpatient Procedure Fees Patients have the right to know how much their private health care will cost. At Greenslopes Obstetrics & Gynaecology, we will always strive to provide full and transparent financial disclosure. Below is a list of our basic consultation fees for Gynaecology services. This list does not include all services provided by our practice and does not include inpatient surgical procedures. Any patient requiring an inpatient surgical procedure will be provided with a full Estimate of Surgical Fees following consultation and assessment with one of our doctors.

Gynaecology

FEE

MEDICARE REBATE

OUT OF POCKET

Gynaecology Consultation with New Referral*

$330

$80.85

$249.15

Follow-up Gynaecology Consultation

$150

$40.65

$109.35

Fertility

FEE

MEDICARE REBATE

OUT OF POCKET

Initial Fertility Consultation for each partner

$330

$80.85

$249.15

Follow-up Fertility Consultation

$150

$40.65

$109.35

Planning & Management of IVF or IUI cycle

$360

$78.85

$281.15

Associated Medical Procedures

FEE

MEDICARE REBATE

OUT OF POCKET

Insertion of IUD (Mirena, Kyleena, Cooper)

$230

$74.65

$155.35

Removal of IUD (Mirena, Kyleena, Cooper)

$80

-

$80

Endometrial Biopsy

$176

$49.70

$126.30

Colposcopy/Vulvoscopy

$230

$59.50

$170.50

Cervical Biopsy in conjunction with Colposcopy

$297

$89.30

$207.70

Cervical/Vaginal Polyp Removal

$182

$59.55

$122.45

Vulval Biopsy in conjunction with Vulvoscopy

$297

$89.30

$207.70

Vulval Biopsy

$250

$65.55

$184.45

Implanon Insertion

$130

$33.15

$96.85

Implanon Removal

$180

$56.55

$123.45

Insertion of Zoladex Implant

$84

$33.15

$50.85

Vaginal Pessary for Prolapse

$67.50

-

$67.50

Pudendal Nerve Block

$298

$93.90

$204.10

Penthrox (‘Green Whistle’)

$80

-

$80

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Not all in-office procedures available are listed above.

Fees for Suite 7.101, Levelabove 7, Nicholson Street Specialist any additional services not listed (e.g. ultrasounds) will beCentre 83 Nicholson St, Greenslopes Qld 4120 advised at time of consultation by your specialist. gsog.com.au

Informed Financial Consent Fertility Management & Procedure Fees The fees outlined below are payable at Greenslopes Obstetrics and Gynaecology. It is separate from the fees payable at Care Fertility, which are outlined in the Fee Schedule from Care Fertility.

IVF

FEE

MEDICARE REBATE

OUT OF POCKET

Planning & Management of IVF or ICSI Cycle (13029)

$360

$76.15

$283.85

Follow-up Consultation After Completion of IVF Cycle

$135

$39.25

$95.75

Egg Pickup & Embryo Transfer

FEE

MEDICARE REBATE

KNOWN GAP (IF INSURED)

Egg Pickup (13212)

$1080

$318.50

$500

Embryo Transfer (13215)

$340

$99.90

$130

Intrauterine Insemination

FEE

MEDICARE REBATE

OUT OF POCKET

Planning & Management of IUI Cycle (13209)

$360

$76.15

$283.85

IUI Cycle Global Fee (13203) (Includes scans/bloods during the cycle, and the insemination procedure)

$1485

$437.40

$1047.60

Once you reach the Extended Medical Safety Net threshold in a calendar year, you may receive a higher Medicare rebate for Outpatient Services.

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au